Cardiovascular Journal of Africa: Vol 29 No 2 (March/April 2018)

43 / 84

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018 AFRICA 105
1115–1122a.
4. Zuhlke L, Karthikeyan G, Engel ME, Rangarajan S, Mackie P, Cupido
B, et al. Clinical outcomes in 3343 children and adults with rheumatic
heart disease from 14 low and middle income countries: 2-year follow-up
of the Global Rheumatic Heart Disease Registry (the REMEDY study).
Circulation 8 Nov 2016.
5. Okello E, Karkande B, Sebatta E, Kayima J, Kuteesa M, Mutatinu B,
et al. Socioeconomic and environmental risk factors among rheumatic
heart disease patients in Uganda. PLoS One 2012; 7(8): e43917.
6. Okello E, Kakande B, Sebatta E, Kayima J, Kuteesa M, Mutatina B, et
al. Cardiovascular complications in newly diagnosed rheumatic heart
disease patients at Mulago Hospital, Uganda. Cardiovasc J Afr 2013;
24(3): 80–85.
7. Watkins D, Zuhlke L, Engel M, Daniels R, Francis V, Shaboodien G, et
al. Seven key actions to eradicate rheumatic heart disease in Africa: the
Addis Ababa communique. Cardiovasc J Afr 2016. 27: 1–5.
8. Yadeta D, Hailu A, Haileamlak A, Gedlu E, Guteta S, Tefera E, et
al. Prevalence of rheumatic heart disease among school children in
Ethiopia: A multisite echocardiography-based screening. Int J Cardiol
2016. 221: 260–263.
9. Ketley D, Woods KL. Impact of clinical trials on clinical practice:
example of thrombolysis for acute myocardial infarction. Lancet 1993;
342(8876): 891–894.
10. Barth, DD, Engel ME, Whitelaw A, Alemseged A, Sadoh WE, Ali
SKM, et al. Rationale and design of the African group A streptococcal
infection registry: the AFROStrep study. Br Med J Open 2016; 6(2):
e010248.
11. Karthikeyan G, Zühlke L, Engel M, Rangarajan S, Yusuf S, Teo K, et
al. Rationale and design of a Global Rheumatic Heart Disease Registry:
The REMEDY study. Am Heart J 2012; 163(4): 535–540.
Anabolic androgenic steroids may be associated with early coronary artery disease
Anabolic androgenic steroids may be associated with early
coronary artery disease, according to research presented
at the Brazilian Congress of Cardiology (SBC 2017). The
annual congress of the Brazilian Society of Cardiology
(SBC) was held in São Paulo from 3 to 5 November 2017.
Experts from the European Society of Cardiology (ESC)
presented a special programme.
‘Anabolic androgenic steroid abuse among young people
is a widespread problem worldwide, and adverse events such
as sudden cardiac death and heart attack have been reported
in athletes,’ said lead author Francis Ribeiro de Souza, PhD
student, Heart Institute (Instituto do Coração; InCor),
Medical School, University of São Paulo (Hospital das
Clínicas da Faculdade de Medicina da Universidade de São
Paulo; HCFMUSP), Brazil. ‘In Brazil, around one million
people have used anabolic androgenic steroids at least once,
and they are the seventh most commonly used drug in the
country,’ he added.
This study examined whether anabolic androgenic steroids
could be associated with early coronary artery disease. It
also tested whether reduced high-density lipoprotein (HDL)
function could be a mechanism leading to coronary artery
disease in anabolic androgenic steroid users.
The study included 51 men with an average age of 29
years (range 23–43 years). Of those, 21 did weight lifting and
had taken anabolic androgenic steroids for at least two years,
20 did weight lifting but did not take steroids, and 10 were
healthy but sedentary.
Participants underwent computed tomography coronary
angiography (a type of imaging used to visualise the arteries)
to assess the presence of atherosclerosis in the coronary
arteries.
A urine test was performed in all participants to confirm
steroid use. Blood samples were taken to measure lipid levels
including HDL. The researchers used cell cultures to measure
the ability of each participant’s HDL to perform its normal
function of removing cholesterol from the macrophages.
The researchers found that 24% of steroid users had
atherosclerosis in their coronary arteries, compared to none
of the non-users and sedentary participants. The steroid
users with atherosclerosis also had significantly reduced
HDL levels and HDL function.
Mr Ribeiro de Souza said: ‘Our study suggests that
anabolic androgenic steroid use may be associated with the
development of coronary artery disease in apparently healthy
young people. Steroids may have an impact on the ability
of HDL to remove cholesterol from macrophages, thereby
promoting atherosclerosis.’
‘This was a small, observational study and we cannot
conclude that steroid use causes atherosclerosis,’ he continued.
‘Larger studies with longer follow up are needed to confirm
these results.’
Mr Ribeiro de Souza concluded: ‘We observed coronary
atherosclerosis in young anabolic androgenic steroid users,
which in combination with lower HDL levels and reduced
HDL function, could increase the risk of cardiovascular
events. Greater awareness is needed of the potential risks of
these drugs.’
Dr Raul Santos, scientific chair of SBC 2017, said: ‘This
study, despite its small sample size, is well done and calls
attention to a possible important health problem in Brazil
and elsewhere, since it shows not only the classical lipid
disturbances induced by steroids but actually associates them
with subclinical atherosclerosis presence, something that we
are not supposed to find in young individuals.’
Professor Fausto Pinto, ESC immediate past president
and course director of the ESC programme in Brazil, said:
‘This is an important issue in cardiovascular prevention,
which deserves further study. During SBC 2017, ESC experts
highlighted hot topics in prevention and other fields of
cardiology that were presented at ESC Congress 2017 in
Barcelona.
Source: European Society of Cardiology Press Office